Pattern of venous thromboembolic diseases in a resources-limited setting in Cameroon

Introduction: Admission for a medical illness is associated with an increased risk of venous thrombo-embolism; however reports addressing at this issue are rare in Cameroon. We sought to assess the pattern of thrombo-embolism among in-medical patients of a semi-urban hospital. Methods: We prospectively included 79 hospitalized medical patients of the Military Hospital of Bamenda (north-west region-Cameroon). From July 2010 and December 2013, we collected baseline demographic data, risk factors of venous thromboembolism, clinical presentation, diagnostic process and treatment. Results: In the 1445 patients admitted for medical illnesses, a total of 79 venous thrombo-embolic diseases were detected (55 deep vein thrombosis, 14 pulmonary embolism, 9 post-phlebitic syndrome and 1 cerulae alba dolens). The leading risk factors were prolonged immobilization (100%), age > 40 years (78.9%), obesity (43%), long distance travel (30.4%) and HIV-AIDS (21.5%). Thirty one (40.5%) had ≤ 2 cumulative risk factors, and 8 (10.1%) more than 4. All the patients in the group had a significant risk of deep vein thrombosis: 5 (6.3%), 34 (43%) and 40 (50.6%) with moderate, high and very high risk respectively. Increasing number of deep vein thrombosis was associated with increasing level of the risk and the clinical probability scores. Lower limb location of deep vein thrombosis was the most frequent with 75 (94.9%) cases. Almost all the patients received appropriate therapy with heparin and oral anticoagulant during their hospital stay. The mean length of hospital stay was 17.5 +/-15 (range 4- 62) days; disability and death occurred in 15 (19%) and 17 (21.5%) respectively. Conclusion: Venous thromboembolism is also a common concern in a semi-urban practice of our country. Long distance travel, one of the leading risk factors merits to be more specifically studied.Pan African Medical Journal 2016; 2

Prise en charge : pré, per et post opératoire chez un drépanocytaire

La drépanocytose est une pathologie héréditaire caractérisée par une anomalie structurale de l'hémoglobine responsable d'un processus de polymérisation en situation de désoxygénation. Cliniquement, elle se manifeste par les épisodes anémiques aigus, des crises vaso-occlusives, des syndromes infectieux graves et des dégénérescences fonctionnelles multiples. En période périopératoire, la drépanocytose se caractérise par une morbidité et une mortalité élevées .La prise en charge préopératoire est dominée par la consultation d'anesthésie qui a pour but d'évaluer le retentissement fonctionnel de la maladie et d'assurer la préparation préopératoire du patient. Cette préparation vise à ramener la concentration de l'HbS autour de 30-40%. En phase peropératoire les modalités anesthésiques sont peu spécifiques, cependant certains impératifs doivent être respectés afin de minimiser le risque de falciformation. L'anesthésie loco-régionale sera privilégiée notamment en obstétrique où la morbidité est élevée. Dans la période post-opératoire, les complications ne sont pas rares. Il s'agit des crises vaso-occlusives, du syndrome thoracique aigu, de l'anémie et des thromboses. La prise en charge de ces complications passe par une bonne oxygénation, une hydratation adéquate , parfois la transfusion, les antalgiques et les antithrombotiques. Mots cles: drépanocytose, prise en charge, péri-opératoire Clinics in Mother and Child Health Vol. 1(1) 2004: 43-5

Kaolin consumption and outcome of surgery in women: a comparative study of 263 operations at the Yaoundé Gyneco-Obstetric and Pediatric Hospital

Background: Kaolin consumption is common in our sub-Saharan Africa. The objective of this study was to assess the effects of kaolin consumption on the outcome of surgery in women.Methods: It was a cohort study comparing the occurrence of complications during labor among 263 consecutively recruited women who underwent gynecologic or obstetric surgery at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Sixty of them (22.8%) declared kaolin consumption before surgery and 203 (77.2%) who denied having consumed kaolin before surgery.Results: Kaolin consumption was found to predispose to postsurgical infections (RR=3.03; IC=1.82-5.05).Conclusions: Kaolin geophagia should be identified before surgery to prevent related postsurgical infections. A systematic ban of kaolin consumption is also recommended.

Therapeutic follow-up of postoperative patients on tramadol in the intensive care unit a tertiary African hospital: a cohort study

Background: Tramadol, an analgesic, is a prodrug requiring bioactivation through cytochrome P450 enzymes (CYP450) to obtain O-desmethyltramadol (M1), its active metabolite. However, little is known on the African pharmacogenetic profile of tramadol metabolism. Hence, we aimed to study the biological efficacy of tramadol in an African population.Methods: This was a prospective cohort study over a 3-month period carried out at intensive care unit of a Cameroonian tertiary hospital. We enrolled patients with moderate-to-severe pain surgery, who had not been administered drugs metabolized by CYP450. Immediately after surgery, 2 mg/kg of tramadol was administered intravenously every 6 hours. Pain was assessed using the visual analog scale (VAS) within the first 24 hours. Vital signs and side effects were recorded. Plasma samples were collected at 3rd and 6th hours to assay tramadol and M1 using HPLC-UV.Results: We enrolled 30 patients with a mean age of 32 years operated for caesarean section, laparotomy and cancer surgery, under spinal and general anesthesia. Before administration of tramadol, the VAS was 6/10. The VAS decreased 4/10 to 1/10 between the 3rdand the 6th hour. There was a reduction of the respiratory rate of 3 breath cycles per minute as early as the 6th hour. Samples from 13 patients were analyzed. M1 was found in all patients; of which 4 had a slow metabolism and 3 had a faster metabolism.Conclusions: Overall there was good correlation between the clinical and biological analgesic efficacy of tramadol

Spontaneous haemorrhagic stroke complicating severe pre-eclampsia in pregnancy: a case report in a resource-limited setting in Cameroon

Abstract Background Spontaneous intracerebral haemorrhage is a rare complication of preeclampsia during pregnancy associated with a high morbidity and mortality. Compared with the non-pregnant women stroke rates are relatively rare during pregnancy. Case presentation We report the case of a 32-year-old female Cameroonian gravida 4 para 3 who presented at 34 weeks of gestation with sudden onset of right sided hemiplegia associated with headache, blurred vision and a blood pressure of 182/126. Cerebral CT scan confirmed a left parietal spontaneous haemorrhage. Emergency caesarean delivery was done and the recovery uneventful. Conclusion This case highlights the importance of good neurological examination in pregnant women presenting with neurological symptoms as well as the place of multidisciplinary management in severe life threatening conditions

Dexaméthasone versus Clonidine utilisés comme adjuvant en ALR pour chirurgie du membre supérieur

Introduction: L’Anesthésie Loco-Régionale périnerveuse (ALR-PN) fait partie des techniques de prise en charge majeures en anesthésie à la fois pour l’anesthésie et l’analgésie post-opératoire. Au Cameroun, l’anesthésie locorégionale périnerveuse échoguidée est une technique peu rependue et n’a jamais fait l’objet d’une étude. L’Hôpital Général de Douala s’est procuré récemment un appareil d’échographie en faveur du service d’anesthésie permettant de réaliser des blocs nerveux périphériques échoguidés. Il nous a semblé important d’une part de décrire cette expérience pionnière dans le pays, et d’autres parts de comparer deux protocoles utilisés dans le cadre de ces blocs nerveux. L’objectif principal de notre étude était de comparer deux protocoles d’anesthésie locorégionale échoguidée utilisés pour le bloc supra claviculaire dans la chirurgie du membre thoracique à l’Hôpital Général de Douala. Méthodologie : Notre avons mené un essai clinique randomisé en simple aveugle sur une période allant d’octobre 2018 à juillet 2019 dans le bloc opératoire de l’Hôpital Général de Douala. Nous avons colligés 76 patients tirés au sort selon la séquence 1/1 et repartis dans deux groupes : Bupivacaïne 0,5% : 0,5ml/kg + Dexaméthasone 4mg et Bupivacaïne 0,5% : 0,5ml/kg + Clonidine 1mcg/kg. Ils ont été comparés du point de vue des variables étudiées (le délai d’installation des blocs moteur et sensitif, la durée des blocs et le degré de satisfaction des patients). Le bloc supra claviculaire était réalisé à l’aide d’un appareil d’échographie portable et la technique échographique utilisée était la technique « In Plane ». L’analyse a été faite grâce au logiciel Epi info version 3.5.4 et Excel 2013. Les tests de Fisher et de Student ont été utilisés pour comparer les moyennes et les variances. Résultats : Les deux groupes étaient comparables du point de vue des données sociodémographiques, des antécédents et des paramètres anthropométriques. L’âge moyen était de 45,21±14,43 ans. Il y avait une prédominance du sexe masculin avec un sex ratio de 1,92. Les fistules artério-veineuses et les ostéosynthèses étaient les principales indications opératoires dans les deux groupes. Le délai d’installation de bloc moteur était de 6,17±0,96 minutes dans le groupe CLONI et 6,17±0,77 minutes dans le groupe DEXA (P=0,43). Le délai d’installation de bloc sensitif était cliniquement plus court dans le groupe CLONI (9,42±1,57 minutes) par rapport au groupe DEXA (10,9±1,66 minutes) P=0,30, L’analyse du score de Bromage moyen dans les deux groupes à H0, H6, H12 et H24 n’a montré aucune supériorité d’un adjuvant par rapport à l’autre. Concernant l’analgésie à la 24H, 82,5% des patients avaient un EVA< 3 dans le groupe DEXA contre 84,45% dans le groupe CLONI P=0,90, L’analyse de l’intensité de la douleur à l’aide de l’EVA à H0, H6, H12 et H24 n’a retrouvé aucune différence statistique entre les deux groupes. Les patients du groupe CLONI étaient plus satisfaits de la qualité de l’anesthésie que ceux du groupe DEXA et il n’y avait pas de différence significative concernant le coût P= 0,93. Conclusion : Dans notre étude, bien qu’en pratique le délai d’installation du bloc semblait subjectivement plus court et la durée de l’analgésie plus longue dans le groupe CLONI, le résultat n’est finalement pas significatif. Mots clés : anesthésie locorégionale échoguidée, bloc supraclaviculaire, Clonidine, dexaméthasone English Title: Dexamethasone versus Clonidine used as adjuvant in locoregional anesthaesia for upper limb surgeryIntroduction: Perinervous Loco-Regional Anesthesia (ALR-PN) is part of major management in anesthesia for both anesthesia and postoperative analgesia.In Cameroon, ultrasound-guided locoregional anesthesia is a technique not much practicised and has never been studied. The Douala General Hospital has recently purchased an ultrasound machine for the anesthesiology unit to produce ultrasound-guided peripheral nerve blocks. We therefore decided to describe this pioneering experience in the country by comparing two protocols used for these perinervous blocks. The main objective of our study was to compare the two ultrasound-guided locoregional anesthesia protocols used by supraclavicular block in thoracic limb surgery at the Douala General Hospital. Methodology: We conducted a randomized, singleblind comparative study between October 2018 and July 2019 in the operating theater of the Douala General Hospital. We collected 76 randomly selected patients in sequence 1/1 and divided into two groups: BUPI 0,5ml / kg + DEXA 4mg and BUPI 0,5ml / kg + CLONI 1mcg / kg. The studied variables were: the intensity and the duration of the motor blocks as well as the degree of satisfaction of the patients. Statistical analysis was done through Epi Infoversion 3.5.4 and Excel 2013 softwares/ Student test and Fisher test were used to compare means with p value trestholl less than 0,05. Results: Both groups were comparable according to sociodemographic data. The mean age was 45.21± 14.43 years old. There was a male predominance with a sex ratio of 1.92. FAV and osteosynthesis were the main type of surgeries. The onset of the motor block was similar, 6.17 ± 0,96 minutes for the CLONI group against 6.17 ± 0,77 minutes for the DEXA group (p = 0,97) with p value of 0,70, Analysis of the mean Bromage Score in the two groups at H0, H6, H12 and H24 showed no superiority of one adjuvant over the other. Regarding analgesia at 24H, 82.5% of patients had an EVA <3 in the DEXA group against 84.45% in the CLONI group with p value= 0,90, The analysis of pain intensity at H0, H6, H12 and H24 EVA showed no difference in the two groups. Patients in the CLONI group were more satisfied with the quality of anesthesia than those in the DEXA group and there was no noticeable difference in the cost of these two protocols (p value= 0,93). Conclusion In our study, we have not found a statistically significant difference between the two groups concerning the efficiency of the two Adjuvant.Key words: ultrasound-guided locoregional anesthesia, Clonidine, dexamethason

The challenge in the diagnosis and management of an advanced abdominal pregnancy in a resource-low setting: a case report

Abstract Background Abdominal pregnancy is a rare form of ectopic pregnancy that is frequently left undiagnosed by inexperienced obstetricians and radiologists. It is associated with higher risk of maternal hemorrhage at any gestation and more at advanced gestation. Case presentation We present the case of a 22-year-old sub-Saharan African woman, gravida 3 para 0, who was diagnosed with advanced abdominal pregnancy of 25 weeks’ gestation by a transvaginal ultrasound after the failure of two medical terminations of pregnancy in the first and second trimesters and a series of repeated obstetric ultrasounds showing intrauterine pregnancy. Laparotomy was done and her recovery was uneventful. Conclusions The management of advanced abdominal pregnancy is more challenging as compared to earlier gestation so patients with failed medical termination of pregnancy should be critically analyzed for ectopic pregnancy as early as possible

Etat vegetatif post-traumatique: quand arrêter la réanimation en zone déshéritée? - Fait clinique

L'état végétatif est l'une des complications les plus redoutables du traumatisme crânien. Les auteurs présentent un cas clinique à propos d'un état végétatif chez une femme de 32 ans suite à un traumatisme crânien après accident de la circulation. La patiente est entrée avec un Glasgow à 6/15. L'évolution a été marquée par la survenue d'une anémie, des convulsions et d'une fièvre à J7 d'hospitalisation. Un état végétatif à été note J38. La prise en charge a consisté en : un remplissage, une antibiothérapie, l'administration du phénobarbital, levo-dopa et du valproate de sodium. La patiente est décédée à J90 de suite d'une surinfection des escarres. Les patients en état végétatif posent beaucoup de problèmes de prise en charge dans les pays en voie de développement, pour des raisons économiques (car n'étant pas assurés) et logistiques (très peu de formations sanitaires sont adaptées à la prise en charge de ces patients en phases primaire et secondaire). Mots cles: etat végétatif, arrêt thérapeutique, prise en charge, pays en voie de développement Clinics in Mother and Child Health Vol. 2(1) 2005: 291-29

Severe Viperidae envenomation complicated by a state of shock, acute kidney injury, and gangrene presenting late at the emergency department: a case report

Abstract Background Snake envenomation is an underestimated pathology in sub-Saharan Africa associated with severe emergencies, and even death in case of late presentation. We herein present a case of severe envenomation managed at the surgical emergency department of the Yaoundé Central Hospital. Case presentation We report a case of a 47-year-old female farmer with no relevant past history who sustained a snakebite by an Echis occellatus viper during an agricultural activity. Her initial management consisted in visiting a traditional healer who administered her some herbal remedies orally and applied a white balm on the affected limb. Due to progressive deterioration of her condition, she was rushed to our surgical department where she arrived 20 h after the snakebite incident. On admission she presented in a state of shock (suggestive of an anaphylactic shock), coagulopathy, renal impairment, and gangrene of the entire right upper limb. Emergency management consisted of fluid resuscitation, repeated boluses of adrenaline, a total of three vials of polyvalent anti-venom sera, promethazine, analgesics, corticosteroids, and administration of fresh frozen plasma. Within four hours of emergency department hospitalisation she developped signs of sepsis and persistent hypotension refractory to fluid resuscitation, suggestive of an associated septic shock. Management pursued with antiobiotherapy and administration of noradrenaline through an electric pump syringe to achieve a mean arterial blood pressure above 65 mmHg. The patient deceased at the 10th hour of hospitalisation in a state of circulatory collapse unresponsive to vasopressors, coagulopathy, renal failure, sepsis and gangrene of the right forearm. Conclusion The authors highlight this unusual presentation but equally pinpoint how late presentation to the emergency department, harmful tradition practices, poverty and cultural beliefs can adversely affect the prognosis of snakebite in our setting

Kaolin consumption and outcome of surgery in women: a comparative study of 263 operations at the Yaound and eacute; Gyneco-Obstetric and Pediatric Hospital

Background: Kaolin consumption is common in our sub-Saharan Africa. The objective of this study was to assess the effects of kaolin consumption on the outcome of surgery in women.Methods: It was a cohort study comparing the occurrence of complications during labor among 263 consecutively recruited women who underwent gynecologic or obstetric surgery at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Sixty of them (22.8%) declared kaolin consumption before surgery and 203 (77.2%) who denied having consumed kaolin before surgery.Results: Kaolin consumption was found to predispose to postsurgical infections (RR=3.03; IC=1.82-5.05).Conclusions: Kaolin geophagia should be identified before surgery to prevent related postsurgical infections. A systematic ban of kaolin consumption is also recommended.